HomeMy WebLinkAboutPermit Electrical 2003-5-6
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225 FIFTH STREET. SPRINGFIELD, OR 97477 · PH:(541)726-3753 · F~iJ~~ nV26-3689
ELECTRICAL PERMIT APPLICATION Zoning
1000 sq. ft. or less
rtJ ,Each additional 500 sq. ft, or
)/ f? ,4,7 r UJ1UJp Cdio. Cf!APft-oa:f portion thereof $ 19.00
cJ mm..L..D law e4ull8S yuu lu
Permits are non-transferable and expire if work is Each ~wqfr4I.&QJJ.LW'(egon I on Utility
not started within 180 days of issuance or if work is MOdJlrar.IQW1~~OO~6d by the Qreg $..eO\'Otif
S d d ~ 180 d F d 01 ow Th SC ~"dA~ are s v . ~r'
uspen e lor ays. ee I 'fication Center. 0 .' -2,.00',
B.
Electrical Contractor Ie. S EI/' /-1-/1 C ,~(tf)'lJJ{ -/k 200 AmflSlHmS. ~he cenoter. g(NoOn\~~i~~~ ~O~f~B~fj)~On
11fu.'1ffli fmJhe ra - - -
O () !l... 't??3 201 Arlij> ~enfiris 1_800_~~?-?34.4$.75.00
Address . _ ,V..Jd)C tJ-'1TJ 401 Amps to 600JAmps $125.00
_ 601 Amps to 1000 Amps $163.00
City tu r~ Phone & p& -0',)",J.-' Over 1000 Amps/Volts $375.00
Reconnect Only $ 50.00
City Job Number
Date
1.
/33 fa -r ~QP~
LEGAL DESCRIPTION "Ii tl rl\
tfl()~f) r~3 U't'LW
JOB DESCRIPTION
2.
Expiration Date
3 V97S
/ (j ,Ii / [) C/
7{)~~-7
J d-/:J()/~ 3
Supervisor License Number
Constr. Contr. Number
Expiration Date
Signature of Supervising Electrician
JJ/AkA: uJ ) Jt
! '~ /
Owners Name ]3t'i!'f' L( LuLJJ P f~ ..-L..
Address I ~ 3 ''7'0 IYLCl /'Q~tL
City g 6 {___i/J Phone 7,2~ - J 9b Y
OWNER INSTALLA nON
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
( f 11A/D (JV\. j~ S' 2-ocJ 3 ) ? ~ .A..fU! ell? cl ~
Date -
l.;oft.
!5-(, -0 '5 I
, ~l
re_
3.
A.
Service Included
$106.00
c.
Installation, Alteration or Relocation
D.
New Alteration or Extension Per Panel
One Circuit 1
Each Additional Circuit or with
Service or Fee<;ler Permit
$ 43.00
$ 3.00
E.
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Residential
Limited Energy/Commercial
$ 50.00
$ 50.00
$ 25.00
$ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
4.
45. C()
?\5
4- ,s;i)
C:;~.LO~
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T:)/Building FormslElectrical Permit Application I-03.doc
City of Springfield
Electrical Permit Attachment
Status: Issued
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
PERMIT NO.:
ISSUED:
APPLIED:
EXPIRES:
ELE2003-00117
5/5/2003
5/5/2003
11/5/2003
SITE ADDRESS: 1336 TAMARACK ST
ASSESSOR'S PARCEL NO.: 1703273304200
PROJECT DESCRIPTION: Electrical for heat pump
Springfield
TYPE OF WORK: New
TYPE OF USE: Residential
ATTENTION:Oregon law re4Ulr~s you to
follow n lies adooted bv the OreQon Utility
ELEC1'Rll({jMti(m:SNPm\.€~R:ules are set fortl
:Er ~~R 952-001-001 0 through OAR 952A001
~~ ~~~~[3 You may obtain copies58h<W&-A1Ms b~
EUGENE O~~dl~e center. (Note: the telephone
CCB # 708~~mb~~(l3~dff@~t~Pj>~otification
- - ~ -..... \
\..Ierner I:::; '-/1\/1 '-,"'')'''.'''~'''.'.
Date Paid Receiot Number
OWNER/APPLICANT:
BERRY LAWRENCE W & B A
1336 TAMARACK ST
SPRINGFIELD OR 97477
Descriotion Amount Paid
+ 10% Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Circ
Minimum! Adjustment Electrical
4.50
3.15
43.00
2.00
05/05/2003
05/05/2003
05/05/2003
05/05/2003
2200200000000000805
2200200000000000805
2200200000000000805
2200200000000000805
To Request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00 a.m. will be made the same
working day, inspections requested after 7:00 a.m. will be made the following working day.
Reauired Insuections: 'OQlH3d ^'VO 09 ~ ^NO~
S\ HO 03~N3WIN tJ
1 Rough Electric: Prior to Cover HO~ 03NoaN'Vg'V aNn 03ZIHOH1{)'tJ
2 Final Electric: When all electrical work is complete. lON S\ 1\INH3d S\Hl H31\.lUS 1\IN'd3d S\Hl
M :1U' ~\ ~H\dX31 vn . 1\'\' nd
By Signature, I state and agree, that I have carefully examined th~Q.plefeoappffcation and do hereby~et ifYffi'at all
information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with
the Ordinances of the City of Springfield and the laws of the State of Oregon pertaining to the work described herein. I further
certify that only contractors and employees who are in compliance with ORS 701.055 will be used on this project. I further agree
to ensure that all required inspections are requested at the proper time, that each address is readable from the street, and that
the approved set of plans, if applicable, will remain on the site at all times during construction.
Owner or Contractors Signature
Date
Page 1 of 1
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
ELE2003-00 117
ELE2003-00117
ELE2003-00 117
ELE2003-00 117
Payments:
Type of Payment
Check
5/5/2003
City of Springfidd
Development Services Department
Public Works Department ~
Official Receipt
Receipt #: 2200200000000000805
Description
Add, Alter, Extend Circ
Minimum! Adjustment Electrical
+ 10% Administrative Fee
+ 7% State Surcharge
Paid By
KS ELECTRIC
8:50:08AM
Received By
ddk
Date: 05/05/2003
Amount Paid
Item Total:
43.00
2.00
4.50
3.15
$52.65
Check Number Confirm No
How Received
In Person
Payment Total:
Amount Paid
52.65
$52.65
Page I of 1
cReceipt.rpt